OPTIONAL/ADDITIONAL INSTRUMENTS
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1 20 Elevated Elevated Rim Liner, 36mm OD x 22mm ID Elevated Rim Liner, 80mm OD x 22mm ID Elevated Rim Liner, 42mm OD x 26mm ID Elevated Rim Liner, 80mm OD x 26mm ID Elevated Rim Liner, 44mm OD x 28mm ID Elevated Rim Liner, 80mm OD x 28mm ID Elevated Rim Liner, 48mm OD x 32mm ID Elevated Rim Liner, 80mm OD x 32mm ID 7mm Offset mm Offset, 40mm OD x 22mm ID mm Offset, 70mm OD x 22mm ID mm Offset, 42mm OD x 26mm ID mm Offset, 70mm OD x 26mm ID mm Offset, 44mm OD x 28mm ID mm Offset, 70mm OD x 28mm ID mm Offset, 48mm OD x 32mm ID mm Offset, 70mm OD x 32mm ID MODULAR ACETABULAR INSTRUMENT SET Instrument Set Case (Includes Base and Lid) Disassembly Device Liner Extractor Liner Elevator Cup Positioner Gunsight Alignment Guide Tibial Alignment Rod Flex Shaft w/modular Connector Drill Bit, 15mm Drill Bit, 30mm Drill Bit, 45mm Drill Guide Tap, 4.5mm Tap, 6.5mm Tap Guide, 4.5mm Tap Guide, 6.5mm Tap Handle Screw Holding Forceps, Screw Holding Forceps, Straight Screwdriver Universal Screwdriver Modular Universal Handle Depth Gauge Torque Limiter OPTIONAL/ADDITIONAL INSTRUMENTS A-Frame Alignment Guide Drill Bit, Short-Flexible (HGP II) Drill Bit, Medium-Flexible (HGP II) Drill Bit, Long-Flexible (HGP II) Replaceable Poly Cap (6 ea.) Replaceable Metal Cap (1 ea.) Liner Inserter (Vacuum) Liner Inserter (Vacuum) Liner Inserter (Vacuum) Liner Inserter (Vacuum) Liner Inserter (Mechanical) Liner Inserter (Mechanical) Liner Inserter (Mechanical) Liner Inserter (Mechanical) Liner Inserter (Mechanical) Liner Inserter (Mechanical) HGP II Cup Pusher Rim Impactor Tray Jumbo Provisional Half Case ACETABULAR REAMERS Acetabular Reamer System Standard Kit (36-70mm) Acetabular Reamer System Jumbo Kit (71-80mm) RIM IMPACTORS Available in 4mm increments Rim Impactor Set Case (Includes Base and Lid) Rim Impactor, 38/40mm Rim Impactor, 78/80mm SHELL PROVISIONALS Cat. No. Description Shell Provisional Set Case (Includes Base and Lid) Shell Provisional, 40mm Shell Provisional, 70mm Jumbo Shell Provisional Set Tray Shell Provisional, 72mm Shell Provisional, 80mm LINER PROVISIONALS Liner Provisionals are available in 2mm increments. Shell sizes 50, 52, and 54 use the same size provisional liner. Locking Screws are ordered separately. POLAR SCREWS (OPTIONAL) Polar Screw Set (Includes seven each of item below) Polar Screw LINER PROVISIONALS 22MM Provisional Liner Set - 22mm Standard Provisional Liner, 22mm Standard Provisional Liner, 22mm Elev. Provisional Liner Set - 22mm Elev. Provisional Liner, 22mm Elev. Provisional Liner, 22mm Elev. Provisional Liner Set - 22mm Elev. Provisional Liner, 22mm Elev. Provisional Liner, 22mm Std Jumbo Provisional Liner Set - 22mm Std Jumbo Provisional Liner, 22mm Std Jumbo Provisional Liner, 22mm Elev. Jumbo Provisional Liner Set - 22mm Elev. Jumbo Provisional Liner, 22mm Jumbo Provisional Liner, 22mm Elev. Jumbo Provisional Liner Set - 22mm Elev. Provisional Liner, 22mm Elev. Provisional Liner, 22mm LINER PROVISIONALS 26MM Provisional Liner Set - 26mm Standard Provisional Liner, 26mm Standard Provisional Liner, 26mm Elev. Provisional Liner Set - 26mm Elev. Provisional Liner, 26mm Elev. Provisional Liner, 26mm Elev. Provisional Liner Set - 26mm Elev. Provisional Liner, 26mm Elev. Provisional Liner, 26mm Std Jumbo Provisional Liner Set - 26mm Std Jumbo Provisional Liner, 26mm Std Jumbo Provisional Liner, 26mm Elev. Jumbo Provisional Liner Set - 26mm Elev. Jumbo Provisional Liner, 26mm Elev. Jumbo Provisional Liner, 26mm Elev. Jumbo Provisional Liner Set - 26mm Elev. Jumbo Provisional Liner, 26mm Elev. Jumbo Provisional Liner, 26mm
2 LINER PROVISIONALS 28MM Cat. No. Description Provisional Liner Set - 28mm Standard Provisional Liner, 28mm Standard Provisional Liner, 28mm Elev. Provisional Liner Set - 28mm Elev. Provisional Liner, 28mm Elev. Provisional Liner, 28mm Elev. Provisional Liner Set - 28mm Elev. Provisional Liner, 28mm Elev. Provisional Liner, 28mm Std Jumbo Provisional Liner Set - 28mm Std Jumbo Provisional Liner, 28mm Std Jumbo Provisional Liner, 28mm Elev. Jumbo Provisional Liner Set - 28mm Elev. Jumbo Provisional Liner, 28mm Elev. Jumbo Provisional Liner, 28mm Elev. Jumbo Provisional Liner Set - 28mm Elev. Jumbo Provisional Liner, 28mm Elev. Jumbo Provisional Liner, 28mm LINER PROVISIONALS 32MM Provisional Liner Set - 32mm Standard Provisional Liner, 32mm Standard Provisional Liner, 32mm Elev. Provisional Liner Set - 32mm Elev. Provisional Liner, 32mm Elev. Provisional Liner, 32mm Provisional Liner Set - 32mm Elev. Provisional Liner, 32mm Elev. Provisional Liner, 32mm Std Jumbo Provisional Liner Set - 32mm Std Jumbo Provisional Liner, 32mm Std Jumbo Provisional Liner, 32mm Elev. Jumbo Provisional Liner Set - 32mm Elev. Jumbo Provisional Liner, 32mm Elev. Jumbo Provisional Liner, 32mm Elev. Jumbo Provisional Liner Set - 32mm Elev. Jumbo Provisional Liner, 32mm Elev. Jumbo Provisional Liner, 32mm LINER PROVISIONALS/INSTRUMENTS 36MM Provisional Liner Set - 36mm Case (Includes Base and Lid) Standard Provisional Liner, 36mm Standard Provisional Liner, 36mm Femoral Head Provisional Femoral Head Provisional /14 Femoral Head Provisional /14 Femoral Head Provisional Liner Inserter Elev. Provisional Liner Set - 36mm Case (Includes Base and Lid) Elev. Provisional Liner, 36mm Elev. Provisional Liner, 36mm Femoral Head Provisional Femoral Head Provisional /14 Femoral Head Provisional /14 Femoral Head Provisional Liner Inserter LINER PROVISIONALS/INSTRUMENTS 40MM Elev. Provisional Liner Set - 40mm Case (Includes Base and Lid) Elev. Provisional Liner, 40mm Elev. Provisional Liner, 40mm /14 Femoral Head Provisional /14 Femoral Head Provisional Liner Inserter LINER PROVISIONALS 7MM OFFSET mm Offset Provisional Liner Set - 22mm mm Offset Provisional Liner, 22mm mm Offset Provisional Liner, 22mm mm Offset Provisional Liner Set - 26mm mm Offset Provisional Liner, 26mm mm Offset Provisional Liner, 26mm mm Offset Provisional Liner Set - 28mm mm Offset Provisional Liner, 28mm mm Offset Provisional Liner, 28mm mm Offset Provisional Liner Set - 32mm mm 7mm Offset Provisional Liner, 32mm mm Offset Provisional Liner, 32mm LINER PROVISIONALS CONSTRAINED Constrained Provisional Liner Set - 32mm Constrained Provisional Liner, 32mm Constrained Provisional Liner, 32mm LINER PROVISIONALS ECCENTRIC Eccentric Provisional Liner Set - 28mm Eccentric Provisional Liner, 28mm Eccentric Provisional Liner, 28mm Eccentric Provisional Liner Set - 32mm Eccentric Provisional Liner, 32mm Eccentric Provisional Liner, 32mm Eccentric Liner Inserter Handle Eccentric Liner Inserter Head, 28mm Eccentric Liner Inserter Head, 32mm LINER PROVISIONALS OBLIQUE Oblique Provisional Liner Set - 22mm Oblique Provisional Liner, 22mm Oblique Provisional Liner, 22mm Oblique Provisional Liner Set - 28mm Oblique Provisional Liner, 28mm Oblique Provisional Liner, 28mm Oblique Provisional Liner Set - 32mm Oblique Provisional Liner, 32mm Oblique Provisional Liner, 32mm Please refer to package insert for complete product information, including contraindications, warnings, precautions, and adverse effects. Contact your Zimmer Representative or visit us at MM Printed in USA 2003 Zimmer, Inc. This surgical technique written in cooperation with Wayne Paprosky, M.D.
3 TRABECULAR METAL MODULAR CUP Surgical Technique
4 TRABECULAR METAL ACETABULAR SHELLS SHELLS are available in 2mm OD increments 6202-SHELL OD-SHELL TYPE Non-Holed Trabecular Metal Acetabular Shell, 38mm, Solid Trabecular Metal Acetabular Shell, 70mm, Solid Cluster-Holed Trabecular Metal Acetabular Shell, 38mm, Cluster Trabecular Metal Acetabular Shell, 80mm, Cluster Multi-Holed Trabecular Metal Acetabular Shell, 38mm, Multi Trabecular Metal Acetabular Shell, 80mm, Multi BONE SCREWS SCREWS are available in 5mm LENGTH increments up to 40mm 6250-SIZE-LENGTH Bone Screw, 4.5x15mm, Self-Tapping Bone Screw, 4.5x40mm, Self-Tapping Bone Screw, 4.5x50mm, Self-Tapping Bone Screw, 4.5x60mm, Self-Tapping Bone Screw, 6.5x15mm, Self-Tapping Bone Screw, 6.5x40mm, Self-Tapping Bone Screw, 6.5x50mm, Self-Tapping Bone Screw, 6.5x60mm, Self-Tapping Bone Screw, 6.5x70mm, Self-Tapping Bone Screw, 6.5x80mm, Self-Tapping Warning: This device is not approved for screw attachment or fixation to the posterior elements (pedicles) of the cervical, thoracic, or lumbar spine. POLYETHYLENE LINER THICKNESS Shell OD Polyethylene Liner (mm) 22mm 26mm 28mm 32mm 36mm 40mm POLYETHYLENE LINERS Liners are available in 2mm increments Shell sizes 50, 52, and 54 use the same size liner Standard Poly Liner, 36mm OD x 22mm ID Poly Liner, 80mm OD x 22mm ID Poly Liner, 42mm OD x 26mm ID Poly Liner, 80mm OD x 26mm ID Poly Liner, 44mm OD x 28mm ID Poly Liner, 80mm OD x 28mm ID Poly Liner, 48mm OD x 32mm ID Poly Liner, 80mm OD x 32mm ID 10 Elevated Elevated Rim Liner, 36mm OD x 22mm ID Elevated Rim Liner, 80mm OD x 22mm ID Elevated Rim Liner, 42mm OD x 26mm ID Elevated Rim Liner, 80mm OD x 26mm ID Elevated Rim Liner, 44mm OD x 28mm ID Elevated Rim Liner, 80mm OD x 28mm ID Elevated Rim Liner, 48mm OD x 32mm ID Elevated Rim Liner, 80mm OD x 32mm ID 20 Elevated Elevated Rim Liner, 36mm OD x 22mm ID Elevated Rim Liner, 80mm OD x 22mm ID Elevated Rim Liner, 42mm OD x 26mm ID Elevated Rim Liner, 80mm OD x 26mm ID Elevated Rim Liner, 44mm OD x 28mm ID Elevated Rim Liner, 80mm OD x 28mm ID Elevated Rim Liner, 48mm OD x 32mm ID Elevated Rim Liner, 80mm OD x 32mm ID 7mm Offset mm Offset, 40mm OD x 22mm ID mm Offset, 70mm OD x 22mm ID mm Offset, 42mm OD x 26mm ID mm Offset, 70mm OD x 26mm ID mm Offset, 44mm OD x 28mm ID mm Offset, 70mm OD x 28mm ID mm Offset, 48mm ODx 32mm ID mm Offset, 70mm OD x 32mm ID Constrained Constrained Liner Set (Includes all liners listed below) mm OD x 32mm ID mm OD x 32mm ID Eccentric Eccentric Liner Set (Includes all 28mm ID liners listed below) Eccentric Liner, 64mm OD x 28mm ID Eccentric Liner, 80mm OD x 28mm ID Eccentric Liner Set (Includes all 32mm ID liners listed below) Eccentric Liner, 64mm OD x 32mm ID Eccentric Liner, 80mm OD x 32mm ID Oblique Oblique Liner Set (Includes all 22mm liners listed below) Oblique Liner, 38mm OD x 22mm ID Oblique Liner, 48mm OD x 22mm ID Oblique Liner Set (Includes all 28mm liners listed below) Oblique Liner, 50mm OD x 28mm ID Oblique Liner, 62mm OD x 28mm ID Oblique Liner Set (Includes all 32mm liners listed below) Oblique Liner, 56mm OD x 32mm ID Oblique Liner, 62mm OD x 32mm ID LONGEVITY CROSSLINKED POLYETHYLENE LINERS Liners are available in 2mm increments. Shell sizes 50, 52 and 54 use the same size liner. Standard Poly Liner, 36mm OD x 22mm ID Poly Liner, 80mm OD x 22mm ID Poly Liner, 42mm OD x 26mm ID Poly Liner, 80mm OD x 26mm ID Poly Liner, 44mm OD x 28mm ID Poly Liner, 80mm OD x 28mm ID Poly Liner, 48mm OD x 32mm ID Poly Liner, 80mm OD x 32mm ID Poly Liner, 50mm OD x 36mm ID Poly Liner, 80mm OD x 36mm ID 10 Elevated Elevated Rim Liner, 36mm OD x 22mm ID Elevated Rim Liner, 80mm OD x 22mm ID Elevated Rim Liner, 42mm OD x 26mm ID Elevated Rim Liner, 80mm OD x 26mm ID Elevated Rim Liner, 44mm OD x 28mm ID Elevated Rim Liner, 80mm OD x 28mm ID Elevated Rim Liner, 48mm OD x 32mm ID Elevated Rim Liner, 80mm OD x 32mm ID Elevated Rim Liner, 50mm OD x 36mm ID Elevated Rim Liner, 80mm OD x 36mm ID Elevated Rim Liner, 58mm OD x 40mm ID Elevated Rim Liner, 80mm OD x 40mm ID
5 1ACETABULAR REAMING Use reamer to prepare acetabular implant site. Hold reamer steady and apply pressure in the same direction that the prosthesis will be implanted. 2COMPONENT SIZING Provisional shell sizes match the outside dimensions of the acetabular reamers. The elliptical Trabecular Metal Modular Acetabular Cup provides 2mm of interference fit at its periphery if the cup size matches the last reamer size used. For example, the 54mm acetabular cup has an outer diameter of 56mm at its rim, but matches the height of the reaming at the polar dome of the cup. Note: The amount of press fit used should be determined at time of surgery and be based upon bone quality. Select the provisional shell that is the same size as the last even-numbered reamer used. Thread the provisional shell onto the positioner securely. Impact the alignment connector to engage onto the taper. Tighten Locking Nut. Alignment Connector Locking Nut 56mm at Periphery Size 54 54mm Spherical Reaming Dimension 8IMPLANT INSERTION The Gunsight or A-Frame Alignment Guides can be used to aid in cup positioning. Use short strikes with a small mallet to impact the cup. The impact required to safely seat the implant is dictated by the bone quality. Due to impaction, it may be necessary to periodically re-tighten the collet or locking nut. Remove the A-Frame or Gunsight device during continued impaction. Use screw holes, or the positioner, to determine if the shell is fully seated Gunsight A-Frame 20
6 3PROVISIONAL SHELL POSITIONING AND ALIGNMENT Ensure the patient is in the correct position. With the Provisional Shell connected to the positioner, insert the Provisional Shell into the prepared site. Keep the slaphammer portion of the positioner vertical, and A-Frame or Gunsight extension parallel with the patient s body, to achieve 45 degrees abduction and 20 degrees forward flexion. Note: The Provisional Shell has protruding, 1mm teeth around the rim for stability during trial reduction. It also has fenestrations so that cup seating can be assessed. Teeth 4PROVISIONAL LINER AND TRIAL RANGE OF MOTION Select the Provisional Liner size that matches the previously selected Provisional Shell. Perform trial reduction. After determining the appropriate style, face angle, and position, mark the bone opposite the positioning mark on the liner. This mark serves as a reference later when positioning the Acetabular Cup. Optional: The Provisional Liner Polar Screw can be used to lock the Provisional Liner and Provisional Shell together during trial reduction. Warning: Do not impact onto the Provisional Liner as damage may occur. Provisional Liner and Shell 9SCREW INSERTION If screw placement is desired, drill a pilot hole by placing the drill through the Drill Guide in the desired screw hole (A). Measure the hole s depth with the Depth Gauge (B). Select the appropriate length screw and insert it in the hole with the Screwdriver (C). Place additional screws as necessary. Warning: Avoid screw placement through the shell into the anterior inferior quadrant of the acetabulum to prevent injury to the neurovascular structures. A B C 10LINER POSITIONING Insert Provisional Liner into prosthesis to check appropriate liner elevation. The anti-rotational slots on the trial liner should line up with the two anti-rotational tabs and black etch marks located on the rim of the shell. Clear all soft tissue from around the perimeter of the shell and assess visualization. To achieve complete congruency, dry inner shell thoroughly. Place the final poly liner with Liner Positioner, or by hand. Align with anti-rotational tabs. Ensure that both tabs are engaged with prosthesis liner slots. Etch Marks Anti-rotational Tabs Anti-rotational Tab and Slot Misaligned Correct Vertical Alignment Shell and Polar Boss Misaligned
7 5POSITIONER ASSEMBLY Alignment Connector Locking Nut Locking Ring Access Thread the implant onto the positioner securely. Position alignment connector as shown. Alignment connector should be in line with locking ring access. Impact alignment connector to engage onto the taper. Tighten Locking Nut. Impaction will be applied primarily to the dome of the implant. Alternatively: The Rim Impactor can be utilized. Remove the cap from the Cup Positioner and replace with the Rim Impactor. The Rim Impactor size should correspond with the implant size selected. The implant should be threaded onto the positioner securely. Impaction will be applied primarily to the rim of the implant. Cap Rim Impactor Warning: Use caution to avoid impacting the antirotational tabs on the rim of the implant. 11LINER INSERTION Push the liner into the shell. Impaction may be necessary to fully engage liner into shell. Watch for the locking tabs to open and then close together. There will be a 2mm to 3mm gap between the locking ring tabs. The prosthetic liner is fully seated when the locking ring tabs can be moved from side-to-side with a probe. The ring serves to lock the liner in place. It must float freely inside the shell to function properly. A Before Insertion B Insertion RING REPLACEMENT 12LOCKING (IF REQUIRED) If upon inspection, during primary or revision surgery, it is determined that the locking ring is not functioning properly or has become damaged, it must be replaced. If seated, the liner is removed using the Disassembly Device to open the ring, while at the same time using the Liner Extractor to clamp and lift the liner out of the shell. C Locked D Fully Seated (side-to-side check)
8 6IMPLANT POSITIONING AND ALIGNMENT 7IMPLANT ORIENTATION Ensure the patient is in the correct position. With the final prosthesis connected to the Acetabular Cup Impactor/Positioner, insert shell into the prepared site. Keep the slap hammer portion of the positioner vertical, and A-Frame or Gunsight extension parallel with the patient s body, to achieve 45 degrees abduction and 20 degrees forward flexion. Slap Hammer Lateral view with A-Frame (from above) The potential for neurologic and vascular injury can be minimized if the posterior quadrants are used for transacetabular screw placement.* The cluster-holed shell should be positioned to allow screw placement in the posterior superior and/or posterior inferior quadrants of the acetabulum. Anterior Superior Posterior Superior Anterior Inferior 12 Posterior Inferior A/P view with Gunsight Lateral view with Gunsight (from above) 12LOCKING RING REPLACEMENT (CONT D) If the ring does not float freely in the shell and is damaged, it must be removed. To remove the old ring, push the ring to the side of the shell and grab the exposed portion on the opposite side of the shell. A firm and steady grip is required. To insert a new ring, first insert the tabs of the ring into the locking ring window. Then, press the ring into place. When properly seated, the ring will first pop into place and then float freely in the shell. Liner assembly can now take place. 13FINAL REDUCTION Perform final reduction to assess range of motion, hip stability, and limb length. If fine tuning or a different liner style is needed, use the Disassembly Device to remove the liner. * Wasielewski RC, Cooperstein LA, Kruger MP, Rubash HE. Acetabular anatomy and the transacetabular fixation of screws in total hip arthroplasty. J Bone Joint Surg. 1990:72-A,4,
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